﻿<%@ Page Language="C#" MasterPageFile="~/MainMaster.master" AutoEventWireup="true" CodeFile="EmailToDentist.aspx.cs" Inherits="Dentist_EmailToDentist" Title="Untitled Page" %>

<asp:Content ID="Content1" ContentPlaceHolderID="MainTable" Runat="Server">
  <div class="heading_inner">
        <div class="heading_topic">
            <h2>Email To Dentist</h2>
        </div>
    </div>

    <div class="cl"></div>

    <!--**Content 1 Starts Here**-->

    <div class="formnew_left" style="background-color: #f4f4f4;">


        <table width="623" border="0" cellspacing="3" class="table_info">

            <tr>

                <td class="bodytxt" align="center">

                    <table width="100%" cellpadding="0" align="center" cellspacing="0" border="0">
                        <tr>
                            <td align="center" style="padding: 0px 0px 8px 0px;">
                                <asp:Label ID="lblMessage" runat="server" Font-Bold="True" ForeColor="Red"></asp:Label></td>
                        </tr>
                        <tr>
                            <td align="center">

                                <asp:MultiView ID="mvEmailToDoctor" runat="server">
                                    <asp:View ID="vwEmailForm" runat="server">
                                        <table cellpadding="0" width="100%" cellspacing="2" border="0" class="table_info">
                                            <tr>
                                                <td width="200">Patient's First Name* :</td>
                                                <td width="280">
                                                    <asp:TextBox ID="txtFirstName" runat="server" CssClass="design" Width="250px" MaxLength="50"></asp:TextBox></td>
                                            </tr>
                                            <tr>
                                                <td>Patient's Last Name* :</td>

                                                <td>
                                                    <asp:TextBox ID="txtLastName" runat="server" Width="250px" MaxLength="50" CssClass="design"></asp:TextBox></td>
                                            </tr>
                                            <tr>
                                                <td>Street Address* :</td>

                                                <td>
                                                    <asp:TextBox ID="txtStreet" runat="server" Width="250px" MaxLength="50" CssClass="design"></asp:TextBox></td>
                                            </tr>
                                            <tr>
                                                <td>City* :</td>

                                                <td>
                                                    <asp:TextBox ID="txtCity" runat="server" Width="250px" MaxLength="50" CssClass="design"></asp:TextBox></td>
                                            </tr>
                                            <tr>
                                                <td>State* :</td>

                                                <td>
                                                    <asp:TextBox ID="txtState" runat="server" Width="250px" MaxLength="50" CssClass="design"></asp:TextBox></td>
                                            </tr>
                                            <tr>
                                                <td>Zip/Postal Code* :</td>

                                                <td>
                                                    <asp:TextBox ID="txtZip" runat="server" Width="250px" MaxLength="15" CssClass="design"></asp:TextBox></td>
                                            </tr>
                                            <tr>
                                                <td>Country* :</td>

                                                <td>
                                                    <asp:TextBox ID="txtCountry" runat="server" Width="250px" MaxLength="50" CssClass="design"></asp:TextBox></td>
                                            </tr>
                                            <tr>
                                                <td>Daytime Phone :</td>

                                                <td>
                                                    <asp:TextBox ID="txtPhone" runat="server" Width="250px" MaxLength="20" CssClass="design"></asp:TextBox></td>
                                            </tr>
                                            <tr>
                                                <td colspan="2">
                                                    <div class="bodytxt" style="font-size: 10px; padding: 2px 0px 2px 2px; margin: 0px 0px 0px 0px;"><b>Tip:</b> Most medical practices can only call you during their normal business hours. Please provide a phone number you can be reached at during weekdays.</div>
                                                </td>
                                            </tr>
                                            <tr>
                                                <td>Cell Phone:</td>

                                                <td>
                                                    <asp:TextBox ID="txtCellPhone" runat="server" Width="250px" MaxLength="20" CssClass="design"></asp:TextBox></td>
                                            </tr>
                                            <tr>
                                                <td>Email Address* :</td>

                                                <td>
                                                    <asp:TextBox ID="txtEmailAddress" runat="server" Width="250px" MaxLength="100" CssClass="design"></asp:TextBox></td>
                                            </tr>
                                            <tr>
                                                <td>Patient's Age* :</td>

                                                <td>
                                                    <asp:TextBox ID="txtPatientAge" runat="server" Width="250px" MaxLength="3" CssClass="design"></asp:TextBox></td>
                                            </tr>
                                            <tr>
                                                <td>Patient's Gender* :</td>

                                                <td>
                                                    <asp:RadioButtonList ID="rbtnPatientGender" CssClass="mainselection" runat="server" RepeatDirection="Horizontal" Width="129px">
                                                        <asp:ListItem Selected="true">Male</asp:ListItem>
                                                        <asp:ListItem>Female</asp:ListItem>
                                                    </asp:RadioButtonList>
                                                </td>
                                            </tr>
                                            <tr>
                                                <td colspan="2" align="left" style="padding: 10px 0px 0px 20px;">What kind of procedure is the patient interested in?</td>
                                            </tr>
                                            <tr>
                                                <td colspan="2" align="left" style="padding: 0px 0px 0px 50px;">
                                                    <asp:TextBox ID="txtProcedurIenterested" runat="server" TextMode="MultiLine" Width="438px" Height="66px" CssClass="design"></asp:TextBox></td>
                                            </tr>
                                            <tr>
                                                <td colspan="2" align="left" style="padding: 10px 0px 10px 20px;">
                                                    <b>We respect your privacy.</b> We do not share your information with any third party. 
											<a href="<%=Session["strHttp"]%>PrivacyPolicy.aspx" target="_blank" title="Privacy Statement">Privacy Statement</a>
                                                </td>
                                            </tr>
                                            <tr>
                                                <td colspan="2" align="left" style="padding: 0px 0px 0px 20px;">What should the doctor know about the patient?</td>
                                            </tr>
                                            <tr>
                                                <td colspan="2" align="left" style="padding: 0px 0px 0px 50px;">
                                                    <asp:RadioButtonList ID="rdbtnAbout" runat="server">
                                                        <asp:ListItem Selected="true">I would like to be called to schedule an appointment.</asp:ListItem>
                                                        <asp:ListItem>I have general questions.</asp:ListItem>
                                                    </asp:RadioButtonList>
                                                </td>
                                            </tr>
                                            <tr>
                                                <td colspan="2" align="center" style="padding: 10px 0px 5px 0px;">
                                                    <asp:Button ID="btnSendEmail" runat="server" CssClass="buttonclass" Text=" Send Email " ToolTip="Click To Send Email ...." OnClick="btnSendEmail_Click" /></td>
                                            </tr>
                                        </table>

                                    </asp:View>

                                    <asp:View ID="vwEmailSent" runat="server">

                                        <table cellpadding="0" width="100%" cellspacing="0" border="0">
                                            <tr>
                                                <td align="center" style="color: Red;">
                                                    <b>Thank you.<br />
                                                        <br />
                                                        Your Message Has Been Sent Successfuly To The Doctor.</b>
                                                </td>
                                            </tr>
                                        </table>

                                    </asp:View>
                                </asp:MultiView>


                            </td>
                        </tr>
                    </table>


                </td>

            </tr>

        </table>
    </div>
    <br />

    <%
	
        if (Equals(mvEmailToDoctor.ActiveViewIndex, 0))
        {
    %>
    <script>
        var frmvalidator = new Validator("aspnetForm", "<%=btnSendEmail.ClientID%>");
        frmvalidator.addValidation("<%=txtFirstName.ClientID %>", "req", "Please Enter First Name.");
        frmvalidator.addValidation("<%=txtLastName.ClientID %>", "req", "Please Enter Last Name.");
        frmvalidator.addValidation("<%=txtStreet.ClientID %>", "req", "Please Enter Stree.");
        frmvalidator.addValidation("<%=txtCity.ClientID %>", "req", "Please Enter City.");
        frmvalidator.addValidation("<%=txtState.ClientID %>", "req", "Please Enter State.");
        frmvalidator.addValidation("<%=txtZip.ClientID %>", "req", "Please Enter Zip Code.");
        frmvalidator.addValidation("<%=txtCountry.ClientID %>", "req", "Please Enter Country.");
        frmvalidator.addValidation("<%=txtEmailAddress.ClientID %>", "req", "Please Enter Email.");
        frmvalidator.addValidation("<%=txtEmailAddress.ClientID %>", "email", "Please Enter a Valid Email.");
        frmvalidator.addValidation("<%=txtPatientAge.ClientID %>", "req", "Please Enter Age.");
        frmvalidator.addValidation("<%=txtPatientAge.ClientID %>", "numeric", "Please Enter Numeric Value For Age.");
        frmvalidator.addValidation("<%=txtProcedurIenterested.ClientID %>", "maxlength=1000", "Maximum Length is Only 1000 Characters");
        frmvalidator.addValidation("<%=txtProcedurIenterested.ClientID %>", "req", "Please Enter 'What kind of procedure is the patient interested in ?'");	
    </script>

    <%
        }
    %>
</asp:Content>
<asp:Content ID="Content2" ContentPlaceHolderID="InnerRight" Runat="Server">
</asp:Content>
<asp:Content ID="Content3" ContentPlaceHolderID="FeaturedBox" Runat="Server">
</asp:Content>
<asp:Content ID="Content4" ContentPlaceHolderID="FeatureDocBox" Runat="Server">
</asp:Content>
<asp:Content ID="Content5" ContentPlaceHolderID="ScriptContent" Runat="Server">
</asp:Content>

